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Drugs and Alcohol Today: Chemsex Edition

A message from the guest editor of this special “Chemsex” edition of Drugs and Alcohol Today | Marcus Day

"Despite a growing number of deaths by overdose or rising incidence of HIV, the wider gay community largely ignored the contribution that illicit drugs, largely synthetic stimulants consumed orally, intranasally or anally but rarely injected, had to morbidity and mortality in their community.

Harm reduction was originally focussed on the prevention of HIV and other blood borne diseases acquired through injecting drug use. The focus of interventions was street based and focussed on people who injected opioids. Despite there being LBGT people represented in harm reduction, there was a prevailing culture of heteronormativity that was a barrier to accessing services for some.

Two challenges needed to be overcome in applying a harm reduction lens to chemsex. First, chemsex is largely a non-injecting drug scene and the World Health Organisation has yet to enunciate the HIV risks associated with non-injecting stimulant use. Second has been the denial and stigmatisation of men participating in chemsex by their gay peers. The first made men who were using drugs through non-injecting routes invisible, while the second created a barrier to accessing services, either with gay men’s health services that often has a palatable aversion to drug use, or traditional heteronormative harm reduction services.

Finding no appropriate services that addressed a growing epidemic of death and disease, chemsex activists took example from the 1980s AIDS epidemic and the community response that addressed a need ignored by the medical and political establishments. The result: a community spurred on to action reminiscent of the actions of the early pre-ART days of the “AIDS crises”."

A message from the guest editor of this special “Chemsex” edition of Drugs and Alcohol Today | Marcus Day | Drugs and Alcohol Today/ Emerald Insight | Apr 2019

Chemsex experiences narratives of pleasure | Maitena Milhet, Jalpa Shah, Tim Madesclaire, and Laurent Gaissad

"The purpose of this paper is to understand the dynamics of pleasure related to chemsex from the perspective of French gay men and other men who have sex with men (MSM). Recognising that participants in chemsex are social actors, the authors diverge from the prominent “pathology paradigm” used in public health.

In-depth interviews were conducted with gay men and other MSM engaging in chemsex via snowball sampling (n=33). The authors explored the definitions of pleasure and the role of stimulants, sexual activity, smartphones and partners in chemsex pleasures.

Chemsex pleasures encompass multiple dimensions that go far beyond bodily pleasures, such as love or romantic relationships, socializing with significant others and sexual discovery through disinhibition. Narratives of pleasure were also, simultaneously, stories of suffering and distress. This dissonance can pose challenges to the participants in chemsex, their entourages and care providers."

Chemsex experiences narratives of pleasure | Maitena Milhet, Jalpa Shah, Tim Madesclaire, and Laurent Gaissad | Drugs and Alcohol Today/ Emerald Insight | Apr 2019

Chemsex origins of the word, a history of the phenomenon and a respect to the culture | David Stuart

"The purpose of this paper is to clarify the origins, use and meaning of the term “chemsex”.

The term chemsex has a definition and a purpose that promotes culturally competent care for a marginalized group of vulnerable people. This is a qualitative, personal, point-of-view piece which may be of value in broadening understandings and responses amongst public health and academic activities.

The findings can be used to develop a sense of community and support amongst men who have sex with men in a chemsex setting, and to provide some background and context for professionals working in this field."

Chemsex origins of the word, a history of the phenomenon and a respect to the culture | David Stuart | Drugs and Alcohol Today/ Emerald Insight | Apr 2019

The problematic chemsex journey a resource for prevention and harm reduction | Tom Platteau, Roger Pebody, Nia Dunbar, Tim Lebacq, and Ben Collins

"Chemsex is a phenomenon that has gained increasing attention in recent years. The purpose of this paper is to differentiate chemsex from other sexualized substance use, and clarify differences between recreational and problematic chemsex use. Despite plentiful publications, little has been published on underlying determinants that predispose individuals to chemsex, and their process toward problematic chemsex use.

During the second European Chemsex Forum, people who engage in chemsex, community organizers, researchers, clinicians, therapists, social workers and (peer) counselors discussed potential pathways to problematic chemsex. In this manuscript, we translate findings from these discussions into a framework to understand the initiation and process toward problematic chemsex.

Six stages (loneliness and emptiness, search for connection, sexual connection, chemsex connection, problematic chemsex and severe health impact) and a set of factors facilitating the transition from one stage to the next have been identified."

The problematic chemsex journey a resource for prevention and harm reduction | Tom Platteau, Roger Pebody, Nia Dunbar, Tim Lebacq, and Ben Collins | Drugs and Alcohol Today/ Emerald Insight | Apr 2019

The psychological roots of chemsex and how understanding the full picture can help us create meaningful support | Katie Evans

"The purpose of this paper is to explore the larger picture of chemsex in a hope to understand how to best work with clients therapeutically. The paper’s aim is to acknowledge not just the risk and “negative” aspects but also what might be gained by men engaging in chems use. How can the chemsex space act as a container for emotions and experiences?

This is a paper based upon cases from within the author’s private practice plus anonymous interviews with men. It comes from a sex positive therapy approach and explores ideas formed within the author's work as a practitioner.

The findings within this paper showed just how complex an issue chemsex is with many layers to it. The author also found that the most important aspect to bear in mind is that this is a very human issue, with aspects many can relate to such as intimacy, self-esteem, desire for connection and dealing with difficult emotions. By seeing what part it plays in the life of men involved then it is possible to can understand how seductive it could be."

The psychological roots of chemsex and how understanding the full picture can help us create meaningful support | Katie Evans | Drugs and Alcohol Today/ Emerald Insight | Apr 2019

Too painful to think about chemsex and trauma | Stephen Morris

"Whilst chemsex is a relatively new phenomenon, trauma is not. Freud borrowed the word from physical medicine, where it was used to describe tissue damage, and applied it, for the first time, as a metaphor to a psychological process by which the protective functioning of the mind can too be pierced and wounded by events. The chemsex environment hosts a myriad of potentially traumatising scenarios and experiences, though perhaps disguised as exhilaration or excitement. The paper aims to discuss these issues.

These experiences piled on top of childhood experiences of being “less than” for being gay, can be responsible for widespread undiagnosed post-traumatic stress disorder (PTSD) among those who engage in chemsex. This paper explores this possibility and offers solutions."

Too painful to think about chemsex and trauma | Stephen Morris | Drugs and Alcohol Today/ Emerald Insight | Apr 2019

What is sober sex and how to achieve it | Remziye Kunelaki

"The purpose of this paper is to provide the first definition of sober sex and recommendations for health care professionals who work therapeutically with patients who struggle with intimacy after experiencing chemsex. The recommendations are based on the clinical experience of a psychosexual therapist working with men having sex with men (MSM) in a Sexual Health clinic in central London. The paper concludes that having a clear definition of sober sex and specific tools, such as healthy masturbation exercise, could prove helpful for health professionals who work with this cohort of patients."

What is sober sex and how to achieve it | Remziye Kunelaki | Drugs and Alcohol Today/ Emerald Insight | Apr 2019

Yes, has no meaning if you can’t say no consent and crime in the chemsex context | Stephen Morris

"The title of this paper is a statement made by a man at the end of his treatment following conviction for several sexual offences. It is powerful in conveying a simple and accurate meaning of consent. Legally, consent is not complicated and can be simply defined as: permission for something to happen or agreement to do something. The context of consent, however, is complicated and complex none more so than when it becomes an issue within chemsex. If we are to gain a full appreciation of consent-related complexity, we must also gain an understanding of the wider picture concerning chemsex and crime. The purpose of this paper is to provide that wider picture. With the exception of breaching of drug-related law, not all men who engage in chemsex are committing offences but, as we are discovering, a not insignificant percentage are and this needs to be cause for concern."

Yes, has no meaning if you can’t say no consent and crime in the chemsex context | Stephen Morris | Drugs and Alcohol Today/ Emerald Insight | Apr 2019

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